Assessing the mental health needs of older people

Mental health and emotional well-being are as important in older age as at any other time of life. Many people fear growing older and assume that growing old is depressing and distressing, characterised by loss and disability, offering little to look forward to. But the reality is that older people are as capable as younger people of enjoying life, taking on challenges, coping with difficulties, engaging in satisfying activities, supporting each other with warmth and good humour, and making a real contribution to their families and communities.

For health and social care professionals, who often meet an older person for the first time during a crisis, it can be hard to keep in mind the positive picture. Low expectations about life quality for older people are widespread among service providers, assessors and older people themselves. However, this is age discrimination, which leads to poor service responses and the social exclusion of older people. Assessment should focus on a person’s strength as well as their difficulties.

Assessing the mental health needs of older people requires the same skills as any other assessment, and is based on the same principles of a person-centred approach and the individual’s right to high standards of assessment and services. People with mental health needs may be more vulnerable, more anxious, more confused, and perhaps have a history of being dismissed as mentally ill. You can help by adopting the same approach as you would to anyone else, by being open, honest, respectful and empathetic.

Evidence

The Department of Health estimates that perhaps 40% of older people seeing their GP, 50% of older people in general hospitals, and 60% of care home residents have a mental health problem. Depression is the most common and most reversible mental health problem in later life, followed by dementia. It is estimated that there are 700,000 people with dementia in the UK, supported by about one million carers.

There is a tendency for older people’s needs to be defined by professionals rather than by the older people themselves. Older people don’t necessarily value the same aspects of an assessment as professionals.

Although there is a substantial literature on mental health in later life, much of it has been driven by researchers and comparatively little has been based on the views of older people themselves. Nevertheless, there is consistent evidence that having a role, good social networks, an adequate income, and living in a supportive neighbourhood are important factors contributing to sound mental health in later life.

Older people are an increasingly diverse group and current research now emphasises the need to look at how mental health is influenced by the interaction of factors such as gender, socio-economic status, and ethnicity. However, despite advances in our ideas about the process of ageing, older people themselves still experience discrimination and older people with mental health problems remain a stigmatised group.

● Don’t panic. Assessing older people with mental health needs requires the same skills as any other assessment, and is based on the same principles. ● Don’t make assumptions. Be open to other possibilities. ● Address the basics. Is the person physically ill? Can they see, hear, understand you? Do they know who you are and what the assessment is for? What effect is the environment having? ● Slow down. Take time to build up trust. Build up a rapport over several visits. At each visit, remind the person who you are and what you talked about last time. Take time to talk around the situation – be unhurried. Do not try to move the person on faster than they can cope with. ● Explain carefully, using simple, everyday language. Avoid jargon. ● Find out about the person’s life, and use prompts such as photos, to get the person talking. Use family members and others who know the person to fill in the gaps. ● Let the person take the lead. Be careful not to guide what the older person is saying. ● Listen carefully for underlying meanings be alert to non-verbal communication such as facial expressions, body language. ● Assume the person has mental capacity, particularly when considering and assessing risks, unless and until there is evidence to the contrary. ● Involve others – family members, advocates, other professionals.

Connect with us

Topics

More information

Our website uses cookies, which are small text files that are widely used in order to make websites work more effectively. To continue using our website and consent to the use of cookies, click click 'Continue'. Find out more.